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Healthcare reform could stifle growth of Ohio community health centers

Updated on June 26, 2017 at 6:08 AMPosted on June 26, 2017 at 6:05 AM

The Neighborhood Family Practice Center in 2014 opened the doors at a new site off Puritas Avenue and West 140th Street. The Neighborhood Family Practice Center's expansion in Cleveland was made possible through a sizable federal grant it received in 2012 from the Affordable Care Act funding. (John Kuntz / The Plain Dealer)

The Neighborhood Family Practice Center in 2014 opened the doors at a new site off Puritas Avenue and West 140th Street. The Neighborhood Family Practice Center's expansion in Cleveland was made possible through a sizable federal grant it received in 2012 from the Affordable Care Act funding. (John Kuntz / The Plain Dealer)

CLEVELAND, Ohio - As lawmakers in Washington, D.C., continue to battle over the specifics of healthcare reform, those at community health centers in Ohio are in a holding pattern.

Under the Affordable Care Act, Federally Qualified Health Centers (FQHCs) were able to expand across the state, opening new locations and hiring more people. Through the ACA, they received more reimbursement for the care they provided and got grants to expand their footprints and services.

Now, with the Senate bill being released, expansion plans are on hold, as those at the community health centers wait to see how the healthcare reform cards will play out. The Senate is expected to vote on its healthcare reform bill, the Better Care Reconciliation Act (BCRA), by July 4.

Jonathan Lee, CEO of FQHC Signature Health, said centers like his made business decisions based on the ACA - decisions about buying new property and hiring new employees.

"All of these were based on the Affordable Care Act, and then to have the course reversed on that is kind of breathtaking. It really, truly, is one-sixth of the economy that you're throwing into fast forward and then slamming into reverse," Lee said.

Medicaid funding largely is at stake in both the Senate and House versions of healthcare reform. These centers, by federal statute, have to serve everyone, regardless of insurance coverage. The ACA's Medicaid expansion, which Gov. John Kasich brought to Ohio in 2014, reimbursed the FQHCs for that care, enabling the centers to take in more patients and expand healthcare services.

At Neighborhood Family Practice, an FQHC on Cleveland's West Side, for example, the center might have received something like $10 before the ACA for caring for an uninsured person, but now gets $100 for providing that care, according to Jean Polster, NFP president and CEO.

"It created a financial stability model for us where we could take risks and do this level of expansion," Polster said.

After the ACA was passed, NFP opened two new centers, established a part-time presence in two Centers for Family and Children and had upped its workforce by 61 percent or 55 full-time equivalent positions. In the year before the ACA, when NFP was part of MetroHealth Care Plus, an early foray into Medicaid expansion, it opened its third center and hired 10 more people.

"Not only have we been offering more care to more people over the past few years, we've been able to offer better quality of care," Polster said.

The Senate's BCRA healthcare reform bill rolls back Medicaid expansion starting in 2021 by gradually reducing funding over three years. That means these centers will increasingly receive less reimbursement for the care they provide.

Even more immediate are changes to Medicaid expansion made in the state Senate budget. The two-year state budget, in its current form, would freeze Medicaid enrollment starting July 1, 2018. Anyone not enrolled by that time will not be able to sign up and anyone who falls off the program because of churn or changes to income will not be able to reapply. Roughly 725,000 Ohioans gained insurance coverage under the state expansion.

The move will effectively end the Medicaid expansion in Ohio because of the level of churn in the program, said Loren Anthes, a public policy fellow at the Medicaid Policy Center.

Between 5 and 10 percent of Signature's patients are uninsured now, a number that will likely climb as high as 30 percent with the rollback of the Medicaid expansion, Lee said.

"I have to start preparing for that today, and I'm not going to build that next building," he said.

Polster didn't want to go so far as to say the NFP would have to close locations or cut services because of changes to Medicaid funding, but she was confident the gains the center has been making in reaching new communities of underserved people and in providing better care would be stalled.

"We're not going to grow to expand access right now. Any plans I would have had to go into disadvantaged neighborhoods, I've put those plans on hold," she said. "We're going to be in a holding pattern right now."

Julie DiRossi-King, COO of the Ohio Association of Community Health Centers, was more direct in her comments during a press conference June 22 at Compass Community Health, an FQHC in southern Ohio.

"More than any other program, Medicaid is essential to our ability to keep our doors open for our communities," DiRossi-King said.

Compass Community Health, like NFP and Signature Health, is one of 49 community health centers in the state that combined now serve 670,000 Ohioans.

The Community Health Center of Greater Dayton (CHCGD) doubled its size under the Medicaid expansion, adding three new centers and more employees to its profile.

"This is multiplied across the state in community health centers and also in rural hospitals," Dr. Matthew Noordsij-Jones of the Dayton center said during a conference call on the effects of the BCRA.

Before the ACA, 40 percent of the CHCGD's patients were uninsured. Today, 5 percent are without health insurance coverage.

"This has been a lifesaver for people but also an economic boon," Noordsij-Jones said.

The reimbursement from Medicaid patients has allowed the Dayton center to hire people, offer preventive care for patients and start to treat the opioid epidemic. Montgomery County, where the center is located, is considered the epicenter of the opioid epidemic.

"Certainly, it's going to make it more of a struggle for us in the future," Noordsij-Jones said of the cuts.